• Matt Schoenherr

Avoid Delayed Onset Hypoglycemia

One of the most feared and unpredictable phenomena in diabetes management is delayed onset hypoglycemia (DOH). Anyone who uses exogenous insulin is at risk of DOH and can happen 3-18 hours after exercise. To learn how to avoid it, we must first learn how and why it happens.


Of course, by now, you have probably realized that most forms of exercise increase insulin sensitivity and that you need to plan accordingly. Something you may not know is that muscles store its own glucose, called glycogen. A trained athlete can store up to 40g of glycogen per 100g of muscle tissue. Highly trained athletes can store as much as 400g of carbs in the muscles!


Long, heavy, exhaustive exercise can deplete a large amount of this muscle and liver glycogen. Afterward, your muscles will want a refill. If you don’t give them the glucose they crave at the right time, they will take it from your blood at the least opportune time; i.e., in the middle of the night while you are sleeping? I would rank that scenario somewhere between dangerous and deadly. People that do not take insulin don’t need to worry about this because their pancreas will stop releasing insulin, keeping the blood sugar stable. Someone with diabetes can go very low, very quickly.


The best way to avoid this is a recovery meal within 45 minutes of completing your workout. During this window, the body is extremely insulin sensitive, and your muscles are primed to accept and store glucose. By using the table below, you can determine how much glucose your muscle burned. Most of the carbs in this meal should have a high glycemic index, a.k.a. fast acting carbohydrates. To aid in recovery from that workout, add a little protein to your recovery snack as well.



If you miss this 45-minute window, your body will briefly go into starvation mode, making your body insulin resistant. Glucose uptake in the muscles will not resume until some random time in the next 6-18 hours. Good luck anticipating that.

The solution is simple, short and sweet.

  • Consume a recovery meal or shake within 45 minutes of ending your workout.

  • Make sure it includes enough simple carbohydrates.

  • Insulin will be required for this post-workout meal, but it may not be as much insulin as you normally need.

For workouts close to home, a smoothie is a great way to get the nutrients and calories to recover and replenish muscle glycogen. If I can't fit a smoothie into the 45 minute window, I drink Endorox R4. Whether its a game, race, practice, or workout, a recovery meal will keep you safe from unpredictable DOH.


References

  1. Hearris, M.A., Hommond, K.M., Fell, J.M., Morton, P.M. Regulation of muscle glycogen metabolism during exercise: implications for endurance performance and training adaptations. Nutrients. 10(3): 298. 2018.

  2. Ivy, J.L., “Dietary strategies to promote glycogen synthesis after exercise,” Canadian Journal of Applied Physiology, 26(Suppl):S236-S245, 2001.

  3. Ivy, J.L., Katz, A.L., Cutler, C.L., et al., “Muscle glycogen synthesis after exercise: effect of time on carbohydrate ingestion,” Journal of Applied Physiology, 64:1480-1485, 1988.

  4. Levenhagen, D.K., Gresham, J.D., Carlson, M.G., et al., “Post exercise nutrient intake timing in humans is critical to recovery of leg glucose and protein homeostasis,” American Journal Physiology, 280:E982-E993, 2001.

  5. Suzuki, M., Doi, T., Lee, S.J., et al., “Effect of meal timing after resistance exercise on hind limb muscle mass and fat accumulation in trained rats,” Journal of Nutritional Science and Vitaminology, 45:401-409, 1999.

  6. Van Loon, L.J.C., Saris, W.H.M., Verhagen, H., et al., “Plasma insulin responses following the ingestion of different amino acid and/or protein mixtures with carbohydrate,” American Journal of Clinical Nutrition, 72:96-105, 2000.

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